title: Minimally invasive treatment of gastric leak after sleeve gastrectomy.
abstract: OBJECTIVE
  Obesity is a leading problem in Western countries, and laparoscopic sleeve gastrectomy (SG) is the most commonly used procedure for the surgical management of morbid obesity. SG is recognised as one of the safest and most effective bariatric procedures but it is limited by a rate of gastric leaks (GL) ranging from 1.4% to 20%. No international consensus exists about the treatment of GL. This paper reports our experience with the noninvasive management of GL.
  
  
  METHODS
  From July 2004 to December 2010, 16 patients with GL after SG were referred to our unit. All patients underwent contrast radiography (Gastrografin) and computed tomography (CT) examination. On the basis of the radiographic findings, patients were divided into those eligible for drainage and those not eligible.
  
  
  RESULTS
  Twelve patients (75%) were eligible for percutaneous drainage. Of these, seven patients (44%) were successfully treated with percutaneous drainage alone, whereas five patients (31%) required placement of a covered stent due to incomplete resolution of the collection. After 1009.8±456.7 days of follow-up, one patient died from a cardiovascular event and two patients required a bilio-pancreatic-digestive bypass (BPD-BP). Twelve patients (75%) were in an excellent state of health with significant reduction of their body mass index (BMI).
  
  
  CONCLUSIONS
  Our experience confirms the value of an algorithm based on patient eligibility for percutaneous drainage in the treatment of GL. The patient's general condition and in particular the presence of sepsis supports the value of this approach in preference to the conventional surgical approach.
authors.affiliation: Vascular and Interventional Radiology Unit, Radiology, Oncology and Pathology Department, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Corona
authors.forename: Chiara
authors.initials: C
authors.lastname: Zini
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Allegritti
authors.forename: Emanuele
authors.initials: E
authors.lastname: Boatta
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cannavale
authors.forename: Andrea
authors.initials: A
authors.lastname: Wlderk
authors.forename: Carlo
authors.initials: C
authors.lastname: Cirelli
authors.forename: Fausto
authors.initials: F
authors.lastname: Fiocca
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Salvatori
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fanelli
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000000981:diagnostic imaging* / Q000601:surgery*; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D004322:Drainage; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009767:Obesity, Morbid / Q000601:surgery*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine